Total body irradiation as preparation for bone marrow transplantation in treatment of acute leukemia and aplastic anemia.
In an attempt to improve survival while minimizing toxicity, many bone marrow transplant centers are now studying the use of cytoreduction regimens with an increased amount of radiation in single-dose or fractionated-exposure schedules for patients with leukemia and aplastic anemia. In order to review the current results, the literature prior to September, 1982 was surveyed and data were tabulated for each transplant center regarding the number of patients receiving transplants, diagnoses, cytoreducation regimen, clinical status, revission duration, relapse rate, causes of death and incidence of interstitial pneumonia. The incidence and severity of cataracts, growth failure, hypothyroidism and second malignant neoplasms were noted, and the data obtained from the literature search were updated and expanded by telephone questionnaire when possible. Marked variation in the technique of transplantation was found among the participating institutions, making it difficult to determine the contribution of the various TBI doses, dose rates and fractionation schedules to the efficacy and toxicity of the combined regimen. In order to define the risk-benefit ratio of the various TBI regimens more clearly, prospective controlled, randomized studies will be required.
Serota
F T
FT
University of Pennsylvania, Bone Marrow Transplant Unit, Philadelphia, USA.
Burkey
E D
ED
August
C S
CS
DAngio
G J
GJ
D000741:Anemia, Aplastic / Q000628:therapy*; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects; D016026:Bone Marrow Transplantation; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D019583:Dose Fractionation, Radiation; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000209:etiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D017564:Radiation Pneumonitis / Q000209:etiology* / Q000401:mortality; D019172:Transplantation Conditioning / Q000379:methods*; D014916:Whole-Body Irradiation / Q000379:methods*
D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide